Demographic Information

  • About me

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    Contact Information

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Insurance Information

My Insurance List

  • Insurance name

    Insurance Information

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    Subscriber Information

    Relation with Card Holder:

    Date of Birth:



Insurance Information

All fields below marked with an asterisk (*) are required.

Subscriber Information

Pending Insurance Information

Relative Account Profile

Full Name: -

Date of Birth: -

Email: -

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Address: -

Manage Sharing My Health Record

You can authorize famlily members to view your medical records and contact clinic staffs via secure messaging. You can discontinue any authorized access and reassign new PIN for a pending access.

Father: Jimmy Fallen []

DOB: 12/21/1957 - Phone: 310-232-1122

waiting for relative confirmation

Authorize a Relative

You need to provide the following information below to authorize your family member view your medical record. If he/she is not in the network, a system email will send out with a link.

Please keep a record of the 4-digit PIN number you set, your family member will need it for the first access to your medical record.

Available Medical Records

Daughter: Jimmy Fallen (DOB: 10/22/1991)

Contact Phone: 310-232-1122

Active access from 10/11/2012 to 10/15/2015

Pending Medical Records

Father: Jimmy Fallen

authorize on 10/11/2012

My Clinic

Avon Outpatient

Address: 6655 East US 36
Avon, IN 46123

Office Hours: Monday-Friday: 9:00am - 5:00pm

Phone: (317) 272-3330

Crawfordsville Outpatient

Address: 701 Englewood Drive
Crawfordsville, IN 47933

Office Hours: Monday-Friday: 9:00am - 5:00pm

Greencastle Outpatient

Address: 308 Medic Way
Greencastle, IN 46135

Office Hours: Monday-Friday: 9:00am - 5:00pm

Indianapolis Outpatient

Address: 5638 Professional Circle
Indianapolis, IN 46241

Office Hours: Monday-Friday: 9:00am - 5:00pm

Lebanon Outpatient

Address: 940 Lasely Drive
Lebanon, IN 46052

Office Hours: Monday-Friday: 9:00am - 5:00pm

My Doctor List


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